THE TREATMENT OF PATIENTS WITH INFECTED IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR SYSTEMS

Objective: The purpose of this study was to evaluate the treatment of patients with infected implantable cardioverter-defibrillator systems. Methods: Retrospective analysis was done of the cases of 21 patients treated for implantable cardioverter-defibrillator infection during an 11-year period. Results: Of 723 cardioverter-defibrillator implantati ons (550 primary implants, 173 replacements), nine (1.2%) were complic ated by early postoperative device-related infections, Late infections developed in two patients 19 and 22 months, respectively, after impla ntation, Ten other patients were transferred to our institution for tr eatment of cardioverter-defibrillator infection. The time from implant ation to overt infection was 2.2 +/- 1.3 months, excluding the two lat e infections, The responsible organisms were Staphylococcus aureus (9) , Staphylococcus epidermidis (6), Streptococcus hemolyticus (1), gram- negative bacteria (3), Candida albicans (1), and Corynebacterium (1), All patients were treated with intravenous antibiotic drugs, Total sys tem removal was done in 15 patients and partial removal in 2; in 4, th e cardioverter-defibrillator system was not explanted, There were no p erioperative deaths, A new implantable cardioverter-defibrillator syst em was reimplanted in 7 patients after 2 to 6 weeks of antibiotic ther apy, Ten patients were treated without reimplantation (2 arrhythmia op eration, 8 antiarrhythmic drugs), Four patients (3 patients without ex plantation and 1 with partial system removal) were treated with mainte nance long-term antibiotic therapy, During a mean follow-up of 21 +/- 2.8 months, no patient had clinical recurrence of infection, One patie nt treated with antiarrhythmic drugs without system reimplantation die d suddenly, Conclusions: Infections that involve implantable cardiover ter-defibrillator systems can be safely managed by removing the entire system with reimplantation after intravenous antibiotic therapy, In s elected patients in whom the risk for system explantation is high and anticipated life expectancy is short, long-term antibiotic therapy to suppress low-virulence infections may represent an acceptable alternat ive.